The only evidence to be found in this research is evidence of bias.

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Recently, the journal Lancet Public Health published a study conducted by researchers at Harvard University and the University of Minnesota warning people that low-carbohydrate diets can cause early death.

They tracked the diet and health of more than 15,000 people for up to 30 years.

People eating diets lower in carbohydrate died sooner than people eating a “moderate” amount of carbohydrate.

Individuals in the lower carbohydrate group seemed to live a little longer if they ate less animal protein.

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Their observations led them to conclude:

“…animal-based low carbohydrate diets, which are more prevalent in North American and European populations, should be discouraged.”

Given the rising popularity of low-carbohydrate diets, this is a bold recommendation with potentially far-reaching implications for public health. Many people will take this study at face value because it is a very large, decades-long, Harvard-affiliated study that passed scientific scrutiny by peer reviewers and was found worthy of publication.

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So, why bother to go beyond the headlines to question its validity? Because it seems curious that low-carbohydrate diets, which make so many people healthier, should somehow simultaneously hasten their demise.

Low-Carbohydrate Diets in the Real World

A growing number of clinicians are successfully prescribing low-carbohydrate diets in their practices to address obesity, type two diabetes, and other serious metabolic disorders. An expanding body of scientific literaturesupports the safety and effectiveness of low-carbohydrate diets, finding that they are at least as good, if not better, than other diets for weight loss. Remarkably, low-carbohydrate diets have the power to put type two diabetes into remission and reverse signs of “metabolic syndrome” such as high insulin, high blood sugar, high blood pressure, high triglycerides, low HDL, and inflammation. Stricter versions of low-carb diets called “ketogenic” diets have been used for nearly a century to treat epilepsy. Emerging science is exploring the potential for ketogenic diets to help manage other neurological disorders, psychiatric disorders, dementia, and even cancer. People around the world are discovering the health benefits of low-carbohydrate diets for themselves and sharing their progress with their friends, family, and on social media. [Full disclosure: I have eaten a low-carbohydrate diet for the better part of the past decade and recommend it as an option to many of my patients.]

If you have improved your own health, lost weight, or been able to cut back on medications by eating a low-carbohydrate diet, should you worry that you are sacrificing years of life for the benefits you have seen?

Of course not.

Let’s take a closer look at the study so you can see for yourself why there is absolutely, positively nothing to be afraid of . . . except bad science.

Where's the Evidence?

Ludicrous Methods. The most important thing to understand is that this study was an "epidemiological" study, which should not be confused with a scientific experiment. This type of study does not test diets on people; instead, it generates guesses (hypotheses) about nutrition based on surveys called Food Frequency Questionnaires (FFQs). Below is an excerpt from the FFQ that was modified for use in this study. How well do you think you could answer questions like these?

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Source: Provided by Lancet Public Health

How is anyone supposed to recall what was eaten as many as 12 months prior? Most people can’t remember what they ate three days ago. Note that “I don’t know” or “I can’t remember” or “I gave up dairy in August” are not options; you are forced to enter a specific value. Some questions even require that you do math to convert the number of servings of fruit you consumed seasonally into an annual average—absurd. These inaccurate guesses become the “data” that form the foundation of the entire study. Foods are not weighed, measured, or recorded in any way.

The entire FFQused contained only 66 questions, yet the typical modern diet contains thousands of individual ingredients. It would be nearly impossible to design a questionnaire capable of capturing that kind of complexity, and even more difficult to mathematically analyze the risks and benefits of each ingredient in any meaningful way. This methodology has been deemed fatally flawed by a number of respected scientists, including Stanford Professor John Ioannidis in this 2018 critique published by JAMA.

Missing Data. Between 1987 and 2017, researchers met with subjects enrolled in the study a total of six times, yet the FFQ was administered only twice: at the first visit in the late 1980s and at the third visit in the mid-1990s. Yes, you read that correctly. Did the researchers assume that everyone in the study continued eating exactly the same way from the mid-1990s to 2017? Popular new products and trends surely affected how some of them ate (Splenda, kale chips, or cupcakes, anyone?) and drank (think Frappucinos, juice boxes, and smoothies). Why was no effort made to evaluate intake during the final 20-plus years of the study? Even if the FFQ method were a reliable means of gathering data, the suggestion that what individuals reported eating in the mid-1990s would be directly responsible for their deaths more than two decades later is hard to swallow.

There are other serious flaws to cover below, but the two already listed above are reasons enough to discredit this study. People can debate how to interpret the data until the low-carb cows come home, but I would argue that there is no real data in this study to begin with. The two sets of "data" are literally guesses about certain aspects of people's diets gathered on only two occasions. Do these researchers expect us to believe they accurately represent participants’ eating patterns over the course of 30 years? This is such a preposterous proposition that one could argue not only that the data are inaccurate, but that they are likely wildly so.

Low-carb diets were not studied. Yes, you read that correctly, too. The lowest-carbohydrate group in the study reported consuming 37% of their approximately 1,558 calories per day as carbohydrate. This 37% translates to a whopping 144 grams of carbohydrate per day. Nowhere else would this be considered a low-carbohydrate diet. Most low-carbohydrate practitioners recommend between 20 and 50 grams of carbohydrate per day. Truly low-carbohydrate diets were not studied. Instead, researchers simply assumed that diets containing even less than 37% carbohydrate would lead to even shorter lives. On the surface of it, this may sound like it makes sense: if lowish is bad, then shouldn't even lower be worse?

The problem with this reasoning is that low-carbohydrate diets tend to have a "threshold effect" on metabolism. This means that most people must drop their carbohydrate intake below a particular “sweet spot” in order to reap benefits. For many, lowering from 150 grams per day to 75 may not make much difference, but dropping below 25 grams per day can bring significant improvements in appetite, weight, blood sugar and insulin levels. Therefore, even if eating 144 grams of carbohydrate per day were dangerous (which this study does not demonstrate), eating 20 grams isn’t necessarily worse, and may for some be better.

No Substitutions. The authors imply that people who eat low-carbohydrate diets can delay meeting their Maker by replacing animal protein with plant protein:

“…mortality increased when carbohydrates were exchanged for animal-derived fat or protein and mortality decreased when the substitutions were plant-based.”

This is rather misleading, as nobody substituted anything for anything else in this study—this was not an experiment. These substitutions took place only in the researchers’ minds.

No Explanations. By saying that low-carbohydrate diets are "associated with greater mortality risk" and that they should therefore be "discouraged," the authors are insinuating that low-carbohydrate diets kill people. If they truly believe this, they have a responsibility to themselves as scientists, to the peer reviewers who accepted their paper for publication, and to the public to explain how carbohydrate restriction endangers lives—particularly given that there is now so much clinical trial evidence demonstrating that carbohydrate restriction can improve the signs and symptoms of some of the deadliest chronic diseases we face.

The only clear attempt made by the authors to offer a plausible mechanism by which low-carbohydrate diets snuff people out is represented by this unreferenced hypothetical statement:

“Long-term effects of a low carbohydrate diet with typically low plant and increased animal protein and fat consumption have been hypothesised to stimulate inflammatory pathways, biological ageing, and oxidative stress.”

Wherever there are people, there are politics, and the world of nutrition science is no exception. There is a paradigm shift occurring in nutrition, and a changing of the guard may be on the horizon. For decades, nutritional epidemiologists at prestigious institutions like the Harvard School of Public Health have occupied virtually all of the seats at the nutrition power brokers' table, and most of them have used their influence to promote low-fat, low-cholesterol, high-plant diets. Their recommendations have been enshrined into the dietary guidelines of the U.S. and many other countries as gospel, even though their arguments have rested almost entirely on "data" generated from Food Frequency Questionnaires such as the one highlighted above, originally developed by renowned Harvard nutrition researcher Dr. Walter Willett, one of the authors of this paper.

The low-fat philosophy upon which these giants have built their reputations has been called into question in recent years by low-carbohydrate clinicians, researchers and community members who witness and document examples every day of low-carbohydrate, high-fat diets improving health. Similar challenges to low-fat, plant-based principles have come from the paleo and carnivore communities which renounce "heart-healthy" whole grains and legumes and embrace animal foods with their naturally-occurring fats as the foundations of a healthy diet.

This summer, the BMJ medical journal together with global re-insurance company Swiss Re hosted a groundbreaking summit in Switzerland entitled Food for Thought: The Science and Politics of Nutrition, intended to foster open dialogue between prominent figures within the low-fat, plant-based community and prominent figures within the low-carb, healthy fat, meat-positive community. One of the central questions posed by the organizers was this:

It was clear that our hosts, Dr. Fiona Godlee of the BMJ and Dr. John Schoonbee of Swiss Re—highly-respected authorities from science and industry—were taking epidemiology to task. What I was privileged to have witnessed over the course of those two days was nothing short of a watershed moment in nutrition history. We critics of epidemiology-based dietary guidelines—the illogical, unfounded, hopelessly complex guidelines that have been destroying our health for decades—were finally being given seats at the big kids' table.

Perhaps the authors of this new paper (including Dr. Walter Willett, who was a panelist at the Swiss conference), were hoping headlines about their research would be passively accepted by the public without scrutiny and delay the washing away of their whole-grain sand castle.

Escaping Epidemi-illogical Escapades

The field of nutritional epidemiology has a dismal track record when it comes to the validity of its guesses—more than 80% of its hypotheses are later proved wrong in clinical trials (human experiments). This is why nutrition headlines are so confusing—one day eggs are bad for us (epidemiology), the next day they are perfectly fine (clinical trials). In my opinion, this study’s thinly-veiled attempt to deter people from embarking on or continuing a healthy low-carbohydrate diet by using smoke-and-mirrors methodologies and invoking images of the Grim Reaper takes this study out of the realm of science and places it squarely in the arena of politics.

These researchers did not conduct a study of low-carbohydrate diets. They dug up some old "data" from epidemiological studies of heart disease, desperately picked through the rubble looking for anything they could find that might support their dying hypothesis, and then repackaged their observations for public consumption.

Don’t be afraid of this paper tiger. There is no evidence of any kind in this study that low-carbohydrate diets—whether they include meat or not—will have you pushing up daisies any sooner than anyone else.

I am almost 62 years old. All my life I had to watch what I ate, I got plenty of exercise and still was always about 25 lbs overweight with very high cholesterol. About 13 months ago I began the Vinnie Tortorich NSNG diet(plus no potatoes). In about 2 months I lost the 25 lbs and this is the first time I have lost weight and kept it off effortlessly. I now weigh what I weighted when I got out of high school. My BMI is 24. My cholesterol went from 285 to 167 and the HDL/LDL Triglycerides ratios are in the ideal range. I eat beef, pork, chicken, good extra-virgin olive oil, butter, high fat cheeses, heavy cream in my coffee, a couple hard boiled eggs daily and all the veggies I want. My fasting glycemic index is averaging 80. It's worked great for me, my Dr was amazed at the difference. Granted, I am just one example but I feel great and am very happy with the diet and results.

The real challenge is trying to get people to see the horrific confirmation bias in nutrition and dietetic science. I have been eating as a zero carb carnivore for 3 years to help manage my type two diabetes. I was able to quit takin insulin, I lost over 100 pounds, and I have never felt better than I do now at 55 yrs olds.

If the hypothesis is that a mixed diet of mostly plants, plant oils and a tiny bit of some lean meat (eaten with sufficient trepidation) will give us strong bones, teeth and muscles; then Zero Carb is the perfect null hypothesis. If eating meat exclusively gives a person strong bones, teeth and muscles then the entire cultural artifice crumbles.

We are the null hypothesis, and therefore we are living nutritional heretics. The lack of studies of the obvious null model just further shows that this is not science. It is belief, ideology, culture, economics - anything but science. In other words; science did not get us here and until there is actual science over the null hypothesis we can never “know”, and the maddening thing is the cultural bias will not allow for study of the null. It is truly cultural insanity to keep insisting on an ineffective course because it supports your beliefs, and then deny the very existence of any better alternatives.

Thanks so much for your work, if I try to really explain this to anyone I come across as a zealous lunatic and it is not worth the social awkwardness.

Imagine what sums are spent on research like this. I know about an ongoing project "Cancer in Generations" with similar questionaires, run by a huge, powerfull and very rich anti cancer organisation, in Denmark. I´m sorry to say, I participated. The result will be based on assumptions and made up memories. We are 50.000 participants, who have made up what we ate. I can assure, that several foods, that I eat a lot, wasn´t even an option on the questionaire; and what did I have a year ago? I am so pleased to hear your reports from the summit - that maybe some higher awareness about the way in which results are collected, is round the corner.

Hello, Signe I have never known anyone personally who had participated in an epidemiological study, so your insight is very interesting and valuable. I do feel hopeful and I do sense a change is in the air!

these drugs will drop LDL to 30 or so, raise HDL and yet there is no decrease in cardiac mortality with people on the drugs...these are spectacular failures as these drugs were slated to replace statins and lead to miracle reductions in CAD mortality...

If A implies B, if not B then not A. It's really pretty simple, but industry money is a stubborn thing at the Best Medical School which has nothing left but an appeal to authority.

Old ideas die hard and there is just too much money and ego caught up in the establishment...

Very enlightening, especially the explanation of the different types of studies. Self-reporting anything (with the exception of personal feelings and opinions) doesn't tell anyone Jack in an experiment. I feel much more comfortable scanning the gammut of headlines having now read this. Thank you!

Heels Water Spring Single And And Shoes gules Women'S Autumn Crystal Drill Season HXVU56546 Sharp High Party I'm a dietitian working the front lines daily helping people reverse metabolic disease with a low carb diet and it works. "Everything in Moderation" as I was taught in graduate school does not.

That picture of Low Carb Joe's gravestone is hysterical, that's a classic! It really made me laugh. But more than that, it actually encompasses what I feel about these particular studies and "expert opinions". I've seen this kind of thing over and over again- "although the low carb diet may help you lose weight, lower your blood sugar, lower your blood pressure, reduce inflammation, cure your acid reflux, give you more energy and normalize your cholesterol, it's dangerous and it will still (somehow, inexplicably) kill you in the end". It's just ridiculous! Oh, and wasn't there another recent, large, long running epidemiological study- (I think it was called the PURE study?)- where they found that the people who ate the lowest amount of carbohydrate lived the longest? Obviously we can't take it too seriously if they found a completely opposite result in another study.

My best friend has been eating a meat and vegetable heavy diet for several years. She dropped all the weight she had packed on during college. Her cholesterol levels flipped - good cholesterol is 150 and bad is 50! The docs and nurses are stunned. She doesn't eat carbs and is in incredible health close to her mid 60s. She's like the Energizer Bunny! My former father-in-law ate only meat and potatoes (wouldn't touch other vegetables), with ice cream as dessert, and he lived until he was 94. I'm thinking this living proof is better than any sanctioned Harvard study!

As I recall, the lower carb (not low carb) group had elevated risk of tuberculosis. So, yeah, people who live in very poor countries with limited access to protein (and also anti-biotics and modern sanitation) probably do die earlier due to diseases which have largely been eradicated in the developed world. But that is hardly relevant to the vast majority of readers of the study, who are far more likely to die from heart disease or diabetes than we are to TB.

I can't even begin to describe how thankful I am for this article. I've been venting for weeks about this ridiculous study!

The thing that bothers me most is people will only read headlines, so they see one headline with "low carb diets will kill you faster" and they carry on with their day believing it! So frustrating, especially given some of the great things low carbohydrate diets do for people.

Also, one other thing that bothers me about this study was the fact that there was no focus or mention on high carbohydrate diets during this study.

Great job, this article as well! And "All Politics, No Science", wow! you find words I never find. I too got massively attacked for my advice on pediatric altering of dogs (as it's done in shelters all the time anyway) when a UC Davis "study" came out that seemed to "prove" to dog owners that altered dogs would be more likely to suffer "joint disorders, cancers and urinary incontinence". So there was a storm among our German Shepherd Dog owners, understandably, and I got attacked for my "dangerous advice", lol. So then I debunked that crap "study" that isn't worth the paper it's typed on, starting in the discussion of mygermanshepherd. org/periodical/gsd-spaying-and-neutering

Now seeing that you had to defend your advice as well, and you did so well, when another crap "study" came out that seemed to discredit your advice, is exciting.

Conversely, disturbing is how much CRAP gets published as "study" these days. And here even Harvard backed. Ridiculous. Embarassing for them! I loved to read your response!

And Alex above is right: "The thing that bothers me most is people will only read headlines" and so take that "study" for granted - if they don't get the chance to read your headline reply: "All Politics, No Science" Precisely!

other aspects of Harvard medical education may be excellent but nutrition (and child psychiatry) are compromised by industry money...

I'm not picking just on Harvard (though the are uniquely bad on the diet heart hypothesis), the child department my own residency program was hopelessly biased on recovered memories in the eighties and factored significantly in the McMartin preschool debacle...any academic department can be corrupted by money or ideology...and many are...Loma Linda nutrition is blinded by ideology not money...

Thanks for this breakdown! It's amazing! It's exactly what I try doing for the keto community myself going to read into studies understanding how data was collected and considered and explain to the layman that headlines might like to sound outrageous, facts are far different. Just had to break down Dr Kim Williams statements on Keto Killing people based on a meta analysys of 17 studies spanning 1980s to 2012 where again... low carb actually meants 10% less than usual... but until we go and find it out, they'll say "keto" cause they saw the trend rise in google searches this year. thanks for supporting factual truth :)

I have been on Keto for a year and did reach my goal weight after yo-yo dieting all my life. I've tried it all. Keeping off now a total of 140lbs. I was so discouraged to see the other study everywhere and was starting to question things and feeling lost. I feel encouraged now, to keep on my healthy path. No one likes to believe it but I'm used to the skeptical looks of others. Thank you again!

Finally an intelligent well written response to the flood of anti low carb dis-info that we are seeing. I'm 67 years old have had 2 heart attacks first at 56 years full cardiac arrest at work. Incredible as the odds were the Paramedic Station was around the corner from our building, saving my life. Second one was 2 years ago. Came on suddenly again zero warning. I was home getting ready for lunch. My home is 5 kilometers from the General Hospital a world class cardiac care hospital. Lucky again. I have been seen by numerous doctors...cardiologists and dietians they tell me to lose some weight they worry that my A1C at 6.3 is a bit high. They said don't have a third MI it will kill you. I was advised to eat 6 smaller meals per day but no mention cutting carbs or insulin resistance. At no time did I learn the full mechanism of inflamation at play here. I am in a cardiac rehab program, eating well according to guidelines and working out. I Even entered a 5k run this spring. Instead of improving my weight was slowly increasing, I felt ok but not great. My daughter came the rescue in January this year. She had me stop drinking cows milk, over the next few months she advised eliminating whole grains...breakfast cereals and bread and any junk carbs left. I had no idea I was consuming so much hidden sugar! In the spring I went to bullet proof coffee for 3 weeks instead of breakfast. Getting to noon without eating suddenly became easy. Soon I just had normal black coffee in the morning and only ate twice a day. I had transitioned into intermittant fasting 16/8 and low carb barely knowing it. For the next 30 days i went all out only 20 to 30 gr of carbs a day. I lost 20 lbs easily. My main goal is 10 more lbs then ramping up my fittnes program. In August I let some carbs of my choosing back in but carefully chosen and measured for now only 2 days per week. I should say I rely on animal protein to do this and that may change in the future. I feel and look much better my wife can't believe the noticible change and the bounce in my step. Please tell me how this could possibly be shortening my life. Even if it were what do I have to lose by trying..... #3 was right around the corner. I was clearly suffering with insulin resistance but had to learn about it on the internet...what gives! My 6 month medical is coming up next month I'm fully confident the results will be much improved. Dr Phil says it best, when confronting bad ideas and behaviour he will say bluntly "and how's that working out for you?" The food and drug establishments have been pushing low fat and ignoring the reality of 40 years of rising obesity and chronic disease. I say "well how's that been working out?"